Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo.

OBJECTIVE: The purpose of this report was to illustrate how an unusual complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo (BPPV) may be recognized and prevented. Recurrence of BPPV after occlusion surgery of the posterior semicircular canal has not previously been reported in the literature, to the authors' knowledge. Failure of occlusion not only permits the continued symptoms of BPPV but also burdens the patient with the additional morbidity of a fistula of the PSCC. The authors describe the successful treatment of a patient with recurrent and incapacitating BPPV after the failure of occlusion surgery of the posterior semicircular canal, when the patient was simultaneously crippled by the distressing morbidity of an iatrogenic fistula.

DESIGN: Case report.

SETTING: Tertiary care referral center.

INTERVENTION: Surgical excision of the fistulous segment of the membranous posterior semicircular canal.

OUTCOME MEASURES: The BPPV was resolved. The distressing symptom of a fistula was eliminated. Hearing was preserved.

CONCLUSION: Failure to completely occlude the posterior semicircular canal during posterior canal occlusion surgery results in recurrence of BPPV and an iatrogenic fistula, both of which are preventable. The occurrence of such an event is described, its management is outlined, and some thoughts are offered about its prevention.